Sigh Ventilation in Patients With Trauma The SiVent Randomized Clinical Trial

被引:9
作者
Albert, Richard K. [1 ,19 ]
Jurkovich, Gregory J. [2 ]
Connett, John [3 ]
Helgeson, Erika S. [3 ]
Keniston, Angela [1 ]
Voelker, Helen [3 ]
Lindberg, Sarah [3 ]
Proper, Jennifer L. [3 ]
Bochicchio, Grant [4 ]
Stein, Deborah M. [5 ]
Cain, Christian [5 ]
Tesoriero, Ron [5 ]
Brown, Carlos V. R. [6 ]
Davis, James [7 ]
Napolitano, Lena [8 ]
Carver, Thomas [9 ]
Cipolle, Mark [10 ]
Cardenas, Luis [11 ]
Minei, Joseph [12 ]
Nirula, Raminder [13 ]
Doucet, Jay [14 ]
Miller, Preston R. [15 ]
Johnson, Jeffrey [16 ]
Inaba, Kenji [17 ]
Kao, Lillian [18 ]
机构
[1] Univ Colorado Med, Dept Radiol, Aurora, South Africa
[2] Univ Calif Davis, Dept Surg, Davis, CA USA
[3] Univ Minnesota, Div Biostat, Minneapolis, MN 55405 USA
[4] Washington Univ, Dept Surg, St Louis, MO USA
[5] Univ Maryland, Dept Surg, Baltimore, MD USA
[6] Univ Texas Austin, Dept Surg, Austin, TX USA
[7] Univ Calif San Francisco, Dept Surg, Fresno, CA USA
[8] Univ Michigan, Dept Surg, Ann Arbor, MI USA
[9] Med Coll Wisconsin, Dept Surg, Milwaukee, WI USA
[10] Lehigh Valley Hlth Network, Dept Surg, Bethlehem, PA USA
[11] Christiana Care Hlth Syst, Dept Surg, Wilmington, DE USA
[12] Univ Texas Southwestern, Dept Surg, Dallas, TX USA
[13] Univ Utah, Dept Surg, Salt Lake City, UT USA
[14] Univ Calif San Diego, Dept Surg, San Diego, CA 92037 USA
[15] Bowman Gray Sch Med, Dept Surg, Winston Salem, NC USA
[16] Henry Ford Hosp, Dept Surg, Detroit, MI USA
[17] Univ Southern Calif, Dept Surg, Los Angeles, CA USA
[18] Univ Texas, Dept Surg, Houston, TX USA
[19] Univ Colorado, Dept Med, 517 Garfield St, Denver, CO 80206 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2023年 / 330卷 / 20期
关键词
ACUTE LUNG INJURY; RESPIRATORY-DISTRESS-SYNDROME; PULMONARY CONSEQUENCES; RECRUITMENT MANEUVERS; GAS-EXCHANGE; SURFACTANT; DEEP; FAILURE; RELEASE; MODEL;
D O I
10.1001/jama.2023.21739
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Importance Among patients receiving mechanical ventilation, tidal volumes with each breath are often constant or similar. This may lead to ventilator-induced lung injury by altering or depleting surfactant. The role of sigh breaths in reducing ventilator-induced lung injury among trauma patients at risk of poor outcomes is unknown.Objective To determine whether adding sigh breaths improves clinical outcomes.Design, Setting, and Participants A pragmatic, randomized trial of sigh breaths plus usual care conducted from 2016 to 2022 with 28-day follow-up in 15 academic trauma centers in the US. Inclusion criteria were age older than 18 years, mechanical ventilation because of trauma for less than 24 hours, 1 or more of 5 risk factors for developing acute respiratory distress syndrome, expected duration of ventilation longer than 24 hours, and predicted survival longer than 48 hours.Interventions Sigh volumes producing plateau pressures of 35 cm H2O (or 40 cm H2O for inpatients with body mass indexes >35) delivered once every 6 minutes. Usual care was defined as the patient's physician(s) treating the patient as they wished.Main Outcomes and Measures The primary outcome was ventilator-free days. Prespecified secondary outcomes included all-cause 28-day mortality.Results Of 5753 patients screened, 524 were enrolled (mean [SD] age, 43.9 [19.2] years; 394 [75.2%] were male). The median ventilator-free days was 18.4 (IQR, 7.0-25.2) in patients randomized to sighs and 16.1 (IQR, 1.1-24.4) in those receiving usual care alone (P = .08). The unadjusted mean difference in ventilator-free days between groups was 1.9 days (95% CI, 0.1 to 3.6) and the prespecified adjusted mean difference was 1.4 days (95% CI, -0.2 to 3.0). For the prespecified secondary outcome, patients randomized to sighs had 28-day mortality of 11.6% (30/259) vs 17.6% (46/261) in those receiving usual care (P = .05). No differences were observed in nonfatal adverse events comparing patients with sighs (80/259 [30.9%]) vs those without (80/261 [30.7%]).Conclusions and Relevance In a pragmatic, randomized trial among trauma patients receiving mechanical ventilation with risk factors for developing acute respiratory distress syndrome, the addition of sigh breaths did not significantly increase ventilator-free days. Prespecified secondary outcome data suggest that sighs are well-tolerated and may improve clinical outcomes.
引用
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页码:1982 / 1990
页数:9
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